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Should Patients Read Doctor's Notes? Wrong Question.

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When you have a doctor's appointment, and she makes some notes and later formalizes them for your medical record, would you like read them? There's been debate over the years about whether patients should read the notes that doctors write about them and their health issues -- in academic circles, in a great Seinfeld episode where Elaine's dermatologist won't let her see what he wrote about her, and more recently in a New York Times piece that discusses the promising OpenNotes project. I think this is the wrong question. Instead, you should walk into your doctor's office with a video camera or tape recorder. More on that in a moment.

The discussion about doctor's notes might seem silly, since for many years we've had the right to go to the medical records department and get copies of our records. So all we're talking about here is making that more convenient, for example, by letting you log into your online account and see the notes there. However, this is much more than convenience, it is a cultural statement: we, the doctors, should sincerely invite you to read our impressions, our thought processes, our decisions; and learn from them, even question them. While this is a powerful statement, we've gotten distracted by this artifact, the doctor's note.

Instead we should focus on the communication it represents. The goal is not to sneak into the doctor's inner thoughts and see what he's really thinking about me, rather it is to gain a deeper understanding of my health and add a channel of communication from the doctor whose precious minutes just aren't enough. (By the way, to those who fear doctors will no longer be able to write what they *really* think, I have two comments. First, patients can already request copies of their records, so be thoughtful in your notes! Second, I would consider supporting a separate area for comments that the doctor sincerely feels are in the patient's best interest not to see and are only for other clinicians, similar to what's done today for mental health records.)

What we should be focusing on here are the best ways for the patient to understand and remember the doctor's guidance, including the Q&A that typically happens during the visit. The doctor's note hardly addresses this. It's designed for the doctor to communicate to other clinicians who will later care for the patient, and in practice it's increasingly full of not-so-useful information included for billing purposes. Sometimes the doctor will create a separate note explaining the plan to the patient, especially if his EMR auto-generates a template for this. But this is uncommon, and it provides only a brief summary of the outcome of the discussion.

I encourage loved ones to take a tape recorder or video camera to their doctor's appointments, especially ones where new or critical issues will be discussed like whether or not to have surgery or how aggressive to be in treating a cancer. Most of us have experienced how little one actually remembers when fear or stress levels are high. Being able to review the conversation again later can make a huge difference in understanding and better decision making.

As a doctor, does it make me nervous when someone wants to record our conversation? Yes. Because it holds me even more accountable to communicating clearly and taking good care of my patients.

This post was cross-posted on e-patients.net.

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